Kozminski David J, Cerf Matthieu J, Feustel Paul J, Kogan Barry A
Division of Urology, Department of Surgery, Albany Medical College, Albany Medical Center, Albany, NY, USA.
Health Data Analytics Group, Albany Medical Center, Albany, NY, USA.
J Robot Surg. 2020 Oct;14(5):745-752. doi: 10.1007/s11701-020-01049-8. Epub 2020 Feb 10.
Robotic-assisted techniques are widespread in urology. However, prolonged preparation time for robotic cases hinders operating room (OR) efficiency and frustrates robotic surgeons. Pre-operative times are an opportunity for quality improvement (QI) and enhancing OR throughput. We have previously shown that pre-operative times in robotic cases are highly variable and that increasing patient complexity was associated with longer times. Our objective was to characterize set-up times in robotic urology cases and to determine whether prolongation was due to robot set-up, in particular.
Patients undergoing robotic-assisted urology procedures at our academic institution had routine peri-operative collection of demographic data and OR time stamps. Following IRB approval, we retrospectively reviewed set-up times from an OR database. Multivariable analysis was used to assess the influence of independent patient variables-gender (M/F), smoking history, age, BMI, American Society of Anesthesiologists (ASA) Physical Status Classification, and Charlson Comorbidity Index (CCI)-on robot set-up times. Institutional factors including procedure, surgeon, and case year were also assessed.
A total of 808 patients undergoing 816 robotic-assisted procedures from 2013 to 2018 met inclusion criteria. Robot set-up times varied only by gender (F > M) but not by general patient complexity. Age, BMI, smoking status, ASA, and CCI did not play a role in prolonging robot set-up times. There was marked variability of robot set-up times, even within procedure type. Robot set-up times generally improved over time for a given surgeon.
Robot set-up time is not affected by patient complexity, in contrast to pre-operative time. It is affected by procedure type and does improve with experience. There is wide variability of robot set-up times and this is an important target for surgical QI.
机器人辅助技术在泌尿外科中广泛应用。然而，机器人手术病例的准备时间过长会影响手术室（OR）效率，并使机器人外科医生感到沮丧。术前时间是质量改进（QI）和提高手术室通量的契机。我们之前已经表明，机器人手术病例的术前时间差异很大，并且患者复杂性增加与时间延长有关。我们的目标是描述机器人泌尿外科手术的设置时间，并确定延长是否特别是由于机器人设置。
在我们的学术机构接受机器人辅助泌尿外科手术的患者在围手术期常规收集人口统计学数据和手术室时间戳。在获得机构审查委员会（IRB）批准后，我们回顾性地审查了手术室数据库中的设置时间。多变量分析用于评估独立患者变量——性别（男/女）、吸烟史、年龄、体重指数（BMI）、美国麻醉医师协会（ASA）身体状况分类和查尔森合并症指数（CCI）——对机器人设置时间的影响。还评估了包括手术、外科医生和病例年份在内的机构因素。
2013年至2018年期间，共有808例患者接受了816例机器人辅助手术，符合纳入标准。机器人设置时间仅因性别而异（女性>男性），但与患者总体复杂性无关。年龄、BMI、吸烟状况、ASA和CCI在延长机器人设置时间方面不起作用。即使在手术类型内，机器人设置时间也存在显著差异。对于给定的外科医生，机器人设置时间通常会随着时间的推移而改善。
与术前时间不同，机器人设置时间不受患者复杂性的影响。它受手术类型影响，并且会随着经验的增加而改善。机器人设置时间存在很大差异，这是手术质量改进的一个重要目标。
